This is the largest scale depression screening of postpartum
women and the first time a full psychiatric assessment has been done in a study
of postpartum women who screened positive for depression.

How the study was
done

The study, which included a depression screening of 10 000
women who had recently delivered infants at single obstetrical hospital, revealed
a large percentage of women who suffered recurrent episodes of major
depression.

The study underscored the importance of prenatal as well as
postpartum screening. Mothers’ and infants’ health and lives hang in the
balance. The lives of several women who were suicidal when staff members called
them for the screening were saved likely as a result of the study’s screening
and immediate intervention.

“In the US, the vast majority of postpartum women with
depression are not identified or treated even though they are at higher risk
for psychiatric disorders,” said Northwestern Medicine lead study author
Katherine L. Wisner, M.D. “It’s a huge public health problem. A woman’s mental
health has a profound effect on foetal development as well as her child’s physical
and emotional development.”

Wisner is director of Northwestern’s Asher Center for the
Study and Treatment of Depressive Disorders and the Norman and Helen Asher
Professor of Psychiatry and Behavioral Sciences and professor of obstetrics and
gynaecology at Northwestern University Feinberg School of Medicine. She’s also
a physician at Northwestern Memorial Hospital.

Confusion around PND

“A lot of women do not understand what is happening to
them,” Wisner said. “They think they’re just stressed or they believe it is how
having a baby is supposed to feel.”

The paper was be published in JAMA Psychiatry March 13. Wisner conducted the research when she
was at the University of Pittsburgh.

In the study, 14% of the women screened positive for
depression. Of that group, 826 received full psychiatric assessments during
at-home visits. Some of the key findings from those assessments:

In women who screened
positive for depression, 19.3% thought of harming themselves. “Most of these
women would not have been screened and therefore would not have been identified
as seriously at risk,” Wisner said. “We believe screening will save lives.”

Suicide accounts for about 20 % of postpartum deaths and is
the second most common cause of mortality in postpartum women.

Many women who screened positive for major depression
postpartum had already experienced at least one episode of depression
previously and, in addition, had an anxiety disorder. The study found 30
percent of women had depression onset prior to pregnancy, 40 % postpartum and
30% during pregnancy. More than
two-thirds of these women also had an anxiety disorder.

“Clinicians need to know that the most common clinical
presentation in the post-birth period is more complex than a single episode of
depression,” Wisner said. “The depression is recurrent and superimposed on an
anxiety disorder.“

Of the women who screened positive for major depression, 22%
had bipolar disorder, the majority of whom had not been diagnosed by their
physicians. There is often a delay in correctly diagnosing bipolar disorder,
which depends on identifying not only the depressed phase but the manic or
hypomanic phase as well. But postpartum is the highest risk period for new
episodes of mania in a woman’s life.

“That’s a very high rate of bipolar disorder that has never
been reported in a population screened for postpartum depression before,” said
Wisner. “It is significant because antidepressant drug treatment alone can
worsen the course of bipolar disorder.”

Depression in
pregnancy a risk

In addition, women who have been pregnant in the past year
are less likely to seek treatment for depression than women who have not been
pregnant, previous research has shown.

Maximizing a woman’s overall mental and physical health in
pregnancy and after childbirth is critically important.

“Depression during pregnancy increases the risk to a woman
and her foetus,” Wisner said. “Depression is a physiological dysregulation
disorder of the entire body.”

Maternal prenatal stress and depression is linked to preterm
birth and low infant birth weight, which increases the risk of cardiovascular
disease. Depression also affects a woman’s appetite, nutrition and prenatal
care and is associated with increased alcohol and drug use. Women with
untreated depression have a higher body mass index preconception, which carries
additional risks.

When a new mother is depressed, her emotional state can
interfere with child development and increases the rate of insecure attachment
and poor cognitive performance of her child, Wisner said.

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